There is no cure for endometriosis and it can be difficult to treat. Treatment aims to ease symptoms so the condition doesn't interfere with your daily life.
Treatment will be given to:
- relieve pain
- slow the growth of endometriosis tissue
- improve fertility
- prevent the disease returning
Deciding which treatment
Your gynaecologist will discuss the treatment options with you and outline the risks and benefits of each.
When deciding which treatment is right for you, there are several things to consider, including:
- your age
- whether your main symptom is pain or difficulty getting pregnant
- whether you want to become pregnant – some treatments may stop you getting pregnant
- how you feel about surgery
- whether you've tried any of the treatments before
Treatment may not be necessary if your symptoms are mild, you have no fertility problems, or if you're nearing the menopause, when symptoms may get better without treatment.
Endometriosis gets better by itself without treatment in about 3 in every 10 cases, but it becomes worse without treatment in about 4 in every 10 cases. One course of action is to keep an eye on symptoms and decide to have treatment if they get worse.
Support from Endometriosis UK, can be very useful if you're learning how to manage the condition.
Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen and naproxen, are usually the preferred painkiller used to treat the pain associated with endometriosis.
This is because they act against the swelling (inflammation) caused by the condition, which may help ease pain and discomfort. It's best to take NSAIDs the day before – or several days before – you expect the period pain.
Paracetamol can be used to treat mild pain. It's not usually as effective as NSAIDs, but may be used if these types of drugs cause any side effects, such as nausea, vomiting and diarrhoea.
Codeine is a stronger painkiller that's sometimes combined with paracetamol or used alone if other painkillers aren't suitable. However, constipation is a common side effect, which may aggravate the symptoms of endometriosis.
For more information, read the Endometriosis UK factsheet on pain relief for endometriosis
The aim of hormone treatment is to limit or stop the production of oestrogen in your body. This is because oestrogen encourages endometriosis tissue to grow and shed. Without exposure to oestrogen, the endometriosis tissue can be reduced, which helps ease the symptoms.
However, hormone treatment has no effect on adhesions – "sticky" areas of tissue that can cause organs to fuse together – and can't improve fertility.
Read more about the complications of endometriosis
Some of the main hormone-based treatments for endometriosis include:
Evidence suggests these hormone treatments are equally effective at treating endometriosis, but they have different side effects.
Although most hormone treatments reduce your chance of pregnancy while using them, only the contraceptive pill or patch and LNG-IUS are licensed to be used as contraceptives.
Progestogens and antiprogestogens are used less commonly these days as they often cause unpleasant side effects.
The combined oral contraceptive pill or patch
The combined contraceptive pill and contraceptive patch contain the hormones oestrogen and progestogen. They can help relieve milder symptoms and can be used over long periods of time. They stop eggs being released (ovulation) and make periods lighter and less painful.
These contraceptives can have side effects, but you can try different brands until you find one that suits you. Your doctor may recommend taking three packs of the pill in a row without a break to minimise the bleeding and improve any symptoms related to the bleeding.
Levonorgestrel-releasing intrauterine system (LNG-IUS)
The Mirena levonorgestrel-releasing intrauterine system (LNG-IUS) is a T-shaped contraceptive device that fits into the womb. It releases a type of progestogen hormone called levonorgestrel.
This hormone prevents the lining of your womb growing quickly, which can help reduce pain and greatly reduces or even stops periods.
The device is put into the womb by a doctor or nurse. Once in place, it can remain effective for up to five years.
Possible side effects of using LNG-IUS include irregular bleeding that may last more than six months, breast tenderness and acne.
Learn more about the IUS
Gonadotrophin-releasing hormone (GnRH) analogues
GnRH analogues are synthetic hormones that bring on a temporary artificial menopause by reducing the production of oestrogen. They're usually taken as a nasal spray or injection.
Menopause-like side effects of GnRH analogues include hot flushes, vaginal dryness and low libido. Sometimes low doses of hormone replacement therapy (HRT) may be recommended in addition to GnRH analogues to prevent these side effects.
They're only prescribed on a short-term basis (normally a maximum of six months at a time) and your symptoms may return after treatment is stopped.
GnRH analogues aren't licensed as a form of contraception, so you should still use contraception in the first month while taking them until they take full effect.
Examples of GnRH analogues include:
Progestogens, such as norethisterone, are synthetic hormones that behave like the natural hormone progesterone. They work by preventing the lining of your womb and any endometriosis tissue growing quickly.
However, they have side effects such as:
- mood changes
- irregular bleeding
- weight gain
Progestogens are usually taken daily in tablet form from days 5 to 26 of your menstrual cycle, counting the first day of your period as day one.
Progestogen tablets aren't an effective form of contraception, so you'll still need to use contraception while taking them if you don't want to get pregnant.
Also known as testosterone derivatives, antiprogestogens are synthetic hormones that work in a similar way to GnRH analogues. They bring on a temporary artificial menopause by decreasing the production of oestrogen.
Side effects of antiprogestogens can include:
- weight gain
- mood changes
- the development of masculine features such as hair growth and a deepening voice
These side effects are often severe and alternative medications are more effective. This means antiprogestogens are usually only prescribed as a last resort if other medications haven't worked.
Like GnRH analogues, antiprogestogens are usually only prescribed for a maximum of six months at a time. Examples of antiprogestogens include danazol and gestrinone.
Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms and fertility. The kind of surgery you have will depend on where the tissue is. The options are:
- laparoscopy – the most commonly used and least invasive technique
Any surgical procedure carries risks. It's important to discuss these with your surgeon before undergoing treatment.
Laparoscopy, also known as keyhole surgery, is a common procedure used to treat endometriosis. Small cuts (incisions) are made in your tummy so the endometriosis tissue can be destroyed or cut out.
Large incisions can be avoided because the surgeon uses an instrument called a laparoscope. This is a small tube with a light source and a camera, which relays images of the inside of your tummy or pelvis to a television monitor.
During laparoscopy, fine instruments are used to apply heat, a laser, an electric current (diathermy) or a beam of special helium gas to the patches of tissue to destroy or remove them.
The procedure is carried out under general anaesthetic, so you'll be asleep and won't feel any pain as it's carried out.
Ovarian cysts, or endometriomas, which are formed as a result of endometriosis, can also be removed using this technique.
Although this kind of surgery can relieve your symptoms and has been shown to improve fertility, problems can sometimes recur, especially if some endometriosis tissue is left behind.
A laparotomy is a more invasive operation used if your endometriosis is severe and extensive, or if some of your organs have fused together.
During the procedure, the surgeon makes a wide cut along the bikini line and opens up the area to access the affected organs and remove the endometriosis tissue.
Recovery time for this type of surgery is longer than for keyhole surgery.
If keyhole surgery and other treatments haven't worked and you've decided not to have any more children, a hysterectomy (removal of the womb) can be an option. However, this is rarely required.
A hysterectomy is a major operation that will have a significant impact on your body. Deciding to have a hysterectomy is a big decision that you should discuss with your GP or gynaecologist.
Hysterectomies can't be reversed and, though unlikely, there's no guarantee the endometriosis symptoms won't return after the operation. If the ovaries are left in place, the endometriosis is more likely to return.
If your ovaries are removed during a hysterectomy, the possibility of needing HRT afterwards should be discussed with you. However, it's not clear what course of HRT is best for women who have endometriosis.
For example, oestrogen-only HRT may cause your symptoms to return if any endometriosis patches remain after the operation. This risk is reduced by the use of a combined course of HRT (oestrogen and progesterone), but this can increase your risk of developing breast cancer.
However, the risk of breast cancer isn't significantly increased until you've reached the normal age for the menopause. Talk to your doctor about the best treatment for you.